Patient and clinician perspectives of online-delivered exercise programmes for  chronic musculoskeletal conditions: a mixed-methods systematic review

Purpose:  To synthesize common or differing perceptions of patients’ and clinicians’ that influence  uptake of online-delivered exercise programmes (ODEPs) for chronic musculoskeletal (MSK) conditions. Methods: Eight databases were searched from inception to April 2023 for studies including (1) patients  with and/or clinicians delivering ODEPs for chronic MSK conditions, and (2) synchronous ODEPs, where  information is exchanged simultaneously (mode A); asynchronous ODEPs, with at least one synchronous  feature (mode B); or no ODEPs, documenting past experiences and/or likelihood of participating in an  ODEP (mode C). Critical Appraisal Skills Programme checklists were used to assess study quality.  Perceptions of patients’ and clinicians’ influencing uptake of ODEPs were extracted. Quantitative and  qualitative data were synthesised and integrated. Results:  Twenty-one studies were included (twelve quantitative, seven qualitative, and two  mixed-methods) investigating the perceptions of 1275 patients and 534 clinicians on ODEP mode A  (n=7), mode B (n=8), and mode C (n=6). Sixteen of the 23 identified perceptions related to satisfaction,  acceptability, usability, and effectiveness were common, with 70% of perceptions facilitating uptake  and 30% hindering uptake. Conclusions:  Findings highlight the need to promote targeted education for patients and clinicians  addressing interconnected perceptions, and to develop evidence-based perception-centred strategies  encouraging integrated care and guideline-based management of chronic MSK conditions. 

 IMPLICATIONS FOR REHABILITATION 

• Almost 70% of perceptions related to satisfaction, acceptability, usability, and effectiveness that  influence the uptake of online-delivered exercise programmes for chronic musculoskeletal conditions  are shared by patients and clinicians. • Patient perceptions that differ from clinicians and that hinder uptake include the risk of misdiagnosis,  lack of social support, and advice from their clinic and/or clinician. • Clinician perceptions that differ from patients and that hinder uptake include risk of last-minute  appointment cancellations, the cost to set-up, and limitations of camera angles. • Implementation of online-delivered exercise programmes may be supported by targeted education  for patients and clinicians that addresses misinformed perceptions.